the aid of a lump sum settlement, and eventually of trying his luck once more down below. It is the disease of a creature with a mind: pit ponies do not suffer from nystagmus. The higher his mental grade the more skilled he becomesthe more likely the worker is to be incapacitated. Surely these are not unfair inferences to draw from all the statements in the Report! The psychologist may claim that his department has not been unduly represented in the investigations, and that the disease is worthy of further examination along his own lines, especially when such prominence is given to the dictum by Llewellyn that "the eye has a greater influence on the mind than has any other part of the body." The opposite view, that is, the expression of mental states by eye symptoms, might be inquired into with advantage to ophthalmic science. To emphasise, for example, the need of a careful refraction of the miner's eyes, and not to press for further exploration of the miner's mind, would betray a sad lack of a sense of proportion. The disease should pass from the hands of the oculist. Take away the oscillation of the eyes, and nothing is left but a complex psycho-neurosis which is costing £300,000 in actual disbursement, £1,000,000 directly and indirectly, and an incalculable amount of misery to the miners and their families. What is the remedy? The Report fails lamentably at this point. Beyond recommending better illumination it is practically silent. The environment is to be altered; the man is merely to be cured when damaged. The Manager feels that more insecurity of compensation may have a salutary effect. The Owner is inclined to cut his loss.

The collected data of the actual eye lesions show nothing new, nor are the explanations attached to them impressive. Faithful to the prevailing notion that severe nervous symptoms can follow directly upon the presence of an error of refraction, many observers have sought the solution of the problem of causation in this direction. Thompson, Romiée and Nieden lay stress on defects of vision: Snell and Dransart think the factor of no importance. Dransart says 90 per cent. are emmetropic, Norman found error in upwards of 90 per cent. This amazing discrepancy alone is sufficient to make specialism suspect in official quarters. Ohm, who appears to have brought to the study of the subject great breadth of view and a really scientific mind, attached no importance to the factor of refractive error, since the proportion of occurrence is not greater than among the general population. On the other hand, Anderson, the most recent writer on this subject, makes error of refraction the chief factor in the disease. The Report does not show how this is to be harmonised with the fact that it is rare to find a perfectly emmetropic person in the general population, and that in any case every man after his early forties is out of focus by reason of presbyopia. That reliance must not be placed upon any ophthalmic surgeon's deductions until his personal equation is known is illustrated by the recent statement of a well-known oculist that he had cured a case of 'shell shock' by prescribing so weak a lens as 125D cylinder for astigmatism. Equally efficacious has been the hypodermic injection of plain water instead of morphia to bring sleep to the restless. Is it in a similar way that "correction of refractive error gives relief to symptoms although it may not bring about cessation of oscillations"?

Ohm alone of all the observers seems to have thought that heterophoria may be one of the important predisposing factors. He offers no opinion as to the cause of the heterophoria, and so perhaps misses an important clue to the origin of the nystagmus. In this direction the oculist should be able to give invaluable help, and Mr Pooley's report may throw some light upon it. There is abundant evidence to be got in the ophthalmic departments that heterophoria is associated with a 'neurotic' state. Unlike errors of refraction, which

are usually regarded as congenital, heterophoria is acquired and may be found to be directly due to emotional stress in a large proportion of cases. Indeed the influence of emotion on ordinary concomitant squint is so common and pro found that it may be suspected as a factor in most cases of disordered muscle balance. Here then, if Ohm is right, may chance to be one of the items of a formula regulating the employment of men in the various occupations in mines.

With regard to the nystagmus, it may well be, as Rivers says, that it plays a part in the production of the psycho-neurotic symptoms. From the evidence adduced, however, such can be only a secondary part. Hundreds of men suffer from nystagmus, without obvious mental symptoms or incapacity. It may be present one day, and obtained only with difficulty the next. In some cases "after prolonged absence from work, well marked neurotic and even hysterical symptoms may appear; in these cases although almost all objective signs have disappeared, the subjective symptoms remain well marked." It is highly probable, therefore, that the nystagmus and the mental symptoms have a common origin, and that the type of patient determines whether the psychical or the physical symptoms shall predominate.

It is surprising that Rivers did not suggest combined psychological investigation and treatment along the lines adopted for the 'shell-shocked' victims of the war. The good results obtained are indisputable, notwithstanding the varying calibre of the medical men engaged therein. As a preliminary measure why not engage half-a-dozen capable psycho-analysts to make an exhaustive examination of the psycho-neurotic symptoms from which the men suffer? The cost of the disease would justify this. The cost per case per year varied in 1920 from £32 in one district to £112 in another. The results of analysis could be collated, and the prospects of cure on a large scale discovered or at least conjectured. The disease might even be prevented by the discovery of a formula showing the likelihood of infection' in any particular case, thus allowing suitable men to be apportioned to the various classes of surface and underground work. Judging by the photographs in the Report of several men affected with the disease, the type likely to suffer should not be difficult to recognise even without applying a formula.

A secondary result of a psycho-analytical enquiry into a disease which by common consent is intimately associated with working in light sometimes so bad as to amount practically to darkness would be a gain of information regarding the mentality of the blind or nearly blind. The application of this knowledge to such problems as the education of blind children might prove so beneficial as to make the expense worth while, whatever the effect upon the disease under review.

Since the publication of the Report an important case, described in the Press as being the first of its kind under the Compensation Act, has been tried in the County Court, wherein the widow of a man sued his employers for £300 compensation. The man had been certified as suffering from miners' nystagmus. Previously he had been strong and healthy, but afterwards his interest in life failed, and he drowned himself. The Judge, who was advised by a Medical Assessor, found sufficient relationship between the disease and the manner of death to decide in favour of the applicant.

Both the tragedy and the possibilities following upon this judgment make it still more desirable that the nature of miners' nystagmus should be fully probed, in the interests of the community generally.

W. INMAN.

REVIEWS.

Fundamental Conceptions of Psychoanalysis. By A. A. BRILL, M.D. George Allen and Unwin. pp. vii + 344. Price: 12s. 6d. net.

English readers who are not conversant with the German language owe Dr Brill a debt of gratitude which should, of itself, ensure a friendly reception of any book written by him; for it was through his translation of Freud's earlier writings that such readers acquired their first knowledge of the doctrines of Psycho-Analysis. But good wine needs no bush, and this book can well afford to be judged on its merits, irrespective of any feeling of indebtedness towards its author which on other grounds we may entertain.

It may perhaps be thought that Dr Brill has chosen too big a title for a work which is elementary in its contents and popular rather than technical both in exposition and in appeal. We might have supposed that the fundamental conceptions of psycho-analysis provided a theme which lent itself to a highly technical and formal treatment of the essentials of psycho-analytic theory, and that some critical or expository reference to Freud's more recent speculative hypotheses would have here been forthcoming. But the introduction to the book allays such expectations and disarms such criticism as might legitimately have been made if this work had been addressed primarily to professional students rather than to "those who are occupying themselves with problems of education and psychology.'

The material of the book is taken from lectures given by Dr Brill at an elementary course in the department of pedagogics of the New York University. The author has therefore tried to avoid technical expressions as much as possible and has "not taken the trouble to clutter this volume with a lot of references, which a book intended for professional people would necessarily demand." But anyone who knows of Dr Brill's activities realizes that all his work is built on Prof. Freud's foundations and is referred to the work of the master for more detailed and more technical information.

Perhaps no more attractive introduction to the whole subject of psychoanalysis has been written than that contained in Dr Brill's first two chapters. He treats historically the development of psycho-analysis from the "cathartic method" and deals in an illuminating manner with "The Symptom: its Nature and Function." Then follow chapters on "The Psychology of Forgetting"; "Psychopathology of Every-day Life"; "Wit: its Technique and Ten dencies"; "The Dream: its Function and Motive"; "Types of Dreams"; "Common Forms of Insanity"; "The Only Child"; "Fairy Tales and Artistic Productions"; "Selections of Vocations."

On all these topics Dr Brill writes with a sure touch and not the least part of the charm of his exposition is due to the wealth of original observations and the appositeness of the illustrations which he brings forward in support of his contentions. A third of the whole volume is devoted to the subject of Dreams, and in this connection the author makes some interesting observations on the production and analysis of artificial dreams, and on the cognate "problem of lying."

The chapters on "The Symptom: its Nature and Function," and on "Common Forms of Insanity" will be specially useful to non-professional

readers, for Dr Brill's psychiatric training leads him to present the findings of psycho-analysis in a broader way than is common to writers who have in mind chiefly those morbid states in which psycho-analytic treatment is most useful, namely, the transference neuroses; and thus the reader is enabled to envisage in a truer perspective the bearings of psycho-analytic theory on all the problems of normal and abnormal mental life.

The chapters on "The Only Child" and "Selections of Vocations" will be helpful to those whose chief desire is to know the practical applications of psycho-analytic teaching. A widespread knowledge of the difficulties in adjustment to life which beset the pathway of the only child, and a clear realization of the folly of attempting to choose for another human being the vocation which he or she should follow, may have profound effects on the health and happiness of future generations.

If we try to discover from Dr Brill's book what the fundamental conceptions of psycho-analysis really are, we may be inclined to reduce them to two: (1) all behaviour is based upon unconscious mentation, and (2) all unconscious mentation is motivated by the wish. These two conceptions come to light in the examination of all those forms of mental and bodily activity which are considered in this book: the symptom, forgetting, the slips and blunders of every-day life, wit, dreams, fairy-tales and artistic productions; and, indeed, they may perhaps be truly regarded as the most fundamental conceptions of psycho-analytic theory.

T. W. M.

Sex Problems in Women. By A. C. MAGIAN, M.D. London: William Heinemann (Medical Books), Ltd, 1922. pp. 219. Price: 12s. 6d.

This book is a series of discursive essays on various aspects of feminine sexuality. The title is misleading as no problems are either formulated or discussed. The book is actually, as the author himself states in the Preface, a compilation from standard works. No original contributions are made to the subject, and the evidence which professional experience has brought the writer is most sparingly adduced. The promise of the introductory chapter, that an attempt will be made to elucidate various problems such as "why a woman should cherish a love-passion for the man who ill-treats and abuses her, etc." (p. 1), is not fulfilled. It can hardly be held that the inference that a woman loves her cruel husband because cruelty causes her sexual satisfaction, affords any explanation of, or insight into, the problem of sex for that type of woman, but no other elucidation is forthcoming. This example is characteristic of how the subject-matter is treated throughout. Some of the ethnological statements succeed in conveying false impressions; thus the 'rite' is transformed into the 'right' of defloration (p. 46). Again, the sacred prostitution practised in Babylon is referred to as a 'penance' (p. 140), whereas it was a propitiatory sacrifice to ensure easy child-birth and general fertility. Some points of treatment seem open to criticism such as the use of local irritants as a cure for masturbation (p. 100), or of marriage for mild cases of nymphomania (p. 76). It is interesting, too, to find valerian still considered an active therapeutic agent. Though abnormal sexual conditions and impulses are acknowledged to be "the active agents in the production of the most diverse forms of mental disease and neurasthenia" (p. 1) the references to psycho-therapy are of the most meagre. To the psycho-pathologist this book can be of no service.

As a whole this is a readable, fair-minded, superficial presentation of wellrecognized facts, but it is no more if it is no less. It is, however, baffling to understand why the author should consider that 30 pages of anatomy and physiology surely unnecessary for the medical readers to whom the book is explicitly addressed-"place the matter on a scientific basis.”

JANE I. SUTTIE.

The Psychology of Misconduct, Vice and Crime. By BERNARD HOLLANDER, M.D. George Allen and Unwin, Ltd. pp. 220. Price: 7s. 6d. net.

This book contains the author's reflections on his experiences of moral derangement in the course of 25 years' practice as a physician specializing in nervous and mental disorders. We are told in the Preface that "it is written from the standpoint of the 'new psychology," but it is difficult to find any justification for this statement. There are so many 'new psychologies' nowadays that we may well be in doubt as to what particular brand is favoured by any writer who is enamoured of this term. Ordinarily, its use implies some reference to the changes introduced into the study of the mind by the work of the psychoanalysts and we are naturally led to expect that any book "written from the standpoint of the 'new psychology"" will show at least some understanding of, if not sympathy with, psycho-analytic theory and practice. It is evident, however, that Dr Hollander does not use 'new psychology' in this sense. It is true that he uses words such as 'repression' and 'sublimation' and insists that "mental analysis can, and should be practised by every medical psychologist"; but although he sometimes uses the terms of psycho-analysis, the concepts to which he applies them belong to an older psychology. "The voice is Jacob's voice, but the hands are the hands of Esau.'

Starting from the fact that "there are a number of elementary instincts and feelings which we possess in common with animals," the author tells us that "these instincts in man do not act blindly as in animals. They are reduced in him to obscure impulses which urge him in certain directions, but leave him to choose the itinerary of his course. Instincts, in man, therefore, are sometimes spoken of as propensities.

The various forms of misconduct are described and correlated with the propensities to which they are due. Drink and drug habits are the result of the propensity to eat and drink; aggressiveness, ill-temper and violence are the outcome of the combative propensity; morbid suspicion, cunning, and deceitfulness arise from suspicion, which is "a protective propensity and hence a necessary quality"; theft is due to the propensity to acquire and hoard; sexual crime is due to "the sexual propensity." On all of these topics the author writes in an easy, popular, style and conveys a considerable amount of information which may prove interesting and instructive to the non-professional reader; but the student will find here hardly any reference to what at the present day we understand by the psychology of misconduct, vice and crime.

Throughout the book an inordinate importance is ascribed to the part played by the intellect in the determination of conduct. Thus we read: "The greater the intellect of a man the greater the check upon his motives and passions (p. 22). Again we are told that some people "though endowed with considerable intellect, still have not enough of it to resist their propensities" (p. 29). "The better furnished his intellect, the greater the check on his actions (p. 179); "it is the highly developed intellect of a man which changes the innate